There is so much to focus on when beginning IVF. Insurance and financing issues. Learning about all the medications, as well as how to inject many of them. Understanding the processes of daily monitoring and blood work, of retrievals and transfers. Deciding how many embryos to transfer back and whether to cryopreserve the others.

Most people do cryopreserve the embryos which are not transferred back on a fresh IVF cycle. These frozen embryos are often thawed and used in a later cycle, either years later after a successful fresh cycle or sooner if the fresh cycle was unsuccessful.

Sometimes, especially in cases where patients only transfer back one embryo, like patients in Long Island IVF’s Single Embryo Transfer Program http://bit.ly/1jjvr3y patients may obtain enough embryos from their first fresh IVF cycle to satisfy all of their family-building needs through subsequent frozen embryo transfers. They may have one baby, then another a few years later, and then yet another…all from one retrieval. Yes, they are the lucky ones.

I remember… almost casually… signing off on the cryo consent, my primary focus being on all the matters that had an immediate effect on my first fresh cycle. I wanted to be pregnant now. I’d worry about what to do with any leftover frozen embryos… after I had all the children I wanted … later. It took a few cycles before I finally had any embryos left over to freeze, but the moment I did, I set in motion a decision more complicated and emotional than I initially imagined.

What to do with excess embryos is about as personal a decision as there is. If you don’t have too many, do you keep transferring them until they are gone? Do you donate them…full genetic siblings to your other children…to another couple? Do you donate them to research if your state allows? Do you just keep them in storage and pay the fees? Do you discard them?

I was reminded of the difficulty of this decision when I read about New Zealand’s law limiting the amount of time that embryos can remain in storage to ten years. http://bit.ly/1f7uypm . Fortunately, there is no such law in New York. It is stressful enough for patients to decide what to do with excess embryos without the government imposing an arbitrary time limit on them.

There is no single right answer. Just a right answer for you.

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If you cryopreserved embryos, are you comfortable with your initial decision on how they should be handled? Or are you undecided?

Unless you’re the Octomom, chances are that if you’ve done IVF, you may have frozen…or cryopreserved… a number of embryos above and beyond the number you elected to transfer back on your fresh IVF cycle. If you were lucky enough to have an excess, that is. (Alas, my first few IVFs back in the dark ages, never produced enough for cryo. But later cycles did.)

So, let’s assume you had a baby from that fresh cycle. You breathe a sigh of relief at your motherhood dream coming true and proceed to enjoy a few years of normalcy with your little miracle. So you’re out there doing the play date thing, having great birthday parties, doing Disney. Not to mention suffering–happily– through Yo Gabba Gabba as you catch yourself singing things like “Don’t bite your friends”…

All the while in the back of your brain there’s some security knowing you’ve got “potential” children…literally frozen in time from when your eggs were younger than they are today. No guarantee, but some level of security nonetheless. They do cross your mind at times.

So the time comes to revisit the clinic with the hope of a successful cryo transfer. Imagine it works again.

The question: Are your two children “twins”?

Well, they were conceived at the same time, as fraternal twins would be. But one has been out living its life for a few years. A big head start. The other was tossed in the freezer. (Oh, I’m just kidding…) But the reality is that one… merely through the judgment call of an embryologist … was ever so carefully placed in a frozen state of existence. It’s potential for life on hold. For years.

So are they “twins”?

Is it defined at conception? Is it occupying the same uterus at the same time?